Health system responsiveness for outpatient care in people with diabetes Mellitus in Tehran

Acknowledgements We would like to thank the people who have collaborated in this study: Mr. K. Ahmadi, Iran's permanent representative at the UN Office in Geneva, Naidoo Nirmala Devi at the WHO, Dr Seyyed Mohammad Sajjad, Dr Sarah Shakerian the Department of Social Medicine.Peer reviewedPublisher PD

Effect of Hydrogenated, Liquid and Ghee Oils on Serum Lipids Profile

BACKGROUND: Trans fatty acids are known as the most harmful type of dietary fats, so this study was done to compare the effects of hydrogenated, liquid and ghee oils on serum lipids profile of healthy adults.    METHODS: This study was a randomized clinical trial conducted on 129 healthy participants aged from 20 to 60 years old who were beneficiaries of Imam-e-Zaman charitable organization. Subjects were randomly divided into 3 groups and each group was treated with a diet containing cooking and frying liquid, ghee, or hydrogenated for 40 days. Fasting serum lipids, including total cholesterol (TC), triglyceride (TG), LDL-cholesterol (LDL-C), HDL-cholesterol (HDL-C), apoprotein A (Apo A), and apoprotein B (Apo B) were measured before and after the study.    RESULTS: TC, TG and Apo B had a significant reduction in the liquid oil group compared to the hydrogenated oil group. In the ghee group TG declined and Apo A increased significantly (p < 0.01). Liquid oil group had a significant reduction in HDL-C, compared to the ghee oil group (P < 0.05).     CONCLUSION: It was concluded that consuming liquid oil along with frying oil caused to reduce all serum lipid levels. However, ghee oil only reduced TG and increased HDL-C levels.      Keywords: Serum lipids, Apoproteins, Liquid oil, Hydrogenated oil, Ghee, Clinical tria

Body Mass Index, Waist-circumference and Cardiovascular Disease Risk Factors in Iranian Adults: Isfahan Healthy Heart Program

Considering the main effect of obesity on chronic non-communicable diseases, this study was performed to assess the association between body mass index (BMI), waist-circumference (WC), cardiometabolic risk factors and to corroborate whether either or both BMI and WC are independently associated with the risk factors in a sample of Iranian adults. This cross-sectional study was performed on data from baseline survey of Isfahan Healthy Heart Program (IHHP). The study was done on 12,514 randomly-selected adults in Isfahan, Najafabad and Arak counties in 2000-2001. Ages of the subjects were recorded. Fasting blood glucose (FBG), 2-hour post-load glucose (2hpp), serum lipids, systolic and diastolic blood pressure (SBP and DBP), BMI, WC, smoking status, and total daily physical activity were determined. Increase in BMI and WC had a significant positive relation with the mean of FBG, 2hpp, SBP, DBP, serum lipids, except for HDL-C (p<0.001 for all). After adjustment for age, smoking, physical activity, socioeconomic status (SES), and BMI, the highest odds ratio (OR) (95% CI) for diabetes mellitus (DM) according to WC was 3.13 (1.93-5.08) and 1.99 (1.15-3.44) in women and men respectively. Moreover, the highest ORs based on BMI with adjustment for age, smoking, physical activity, SES, and WC were for dyslipidaemia (DLP) [1.97 (1.58-2.45) in women and 2.96 (2.41-3.63) in men]. The use of BMI or WC alone in the models caused to enhance all ORs. When both BMI and WC were entered in the model, the ORs for all risk factors, in men, according to BMI, were more compared to WC. However, in women, ORs for DM and hypertension (HTN) in WC quartiles were more than in BMI quartiles. BMI is the better predictor of DM, HTN, and DLP in men compared to WC. Conversely, in women, WC is a superior predictor than BMI, particularly for DM and HTN. Furthermore, the measurement of both WC and BMI in Iranian adults may be a better predictor of traditional risk factors of CVDs compared to BMI or WC alone

Clinical characteristics and outcomes of diabetics hospitalized for COVID-19 infection

Some debates exist regarding the association of diabetes mellitus (DM) with COVID-19 infection severity and mortality. In this study, we aimed to describe and compare the clinical characteristics and outcomes of hospitalized COVID-19 patients with and without DM. In this single-centered, retrospective, observational study, we enrolled adult patients with COVID-19 who were admitted to the Shariati hospital, Tehran, Iran, from February 25, 2020, to April 21, 2020. The clinical and paraclinical information as well as the clinical outcomes of patients were collected from inpatient medical records. A total of 353 cases were included (mean age, 61.67 years; 57.51 % male), of whom 111 patients were diabetics (mean age, 63.66 years; 55.86 % male). In comparison to those without DM, diabetic patients with COVID-19 were more likely to have other comorbidities, elevated systolic blood pressure (SBP), elevated blood sugar (BS), lower estimated glomerular filtration rate (eGFR) and elevated blood urea nitrogen (BUN). The association of DM with severe outcomes of COVID-19 infection (i.e. mechanical ventilation, median length of hospital stay and mortality) remained non-significant before and after adjustments for several factors including age, sex, body mass index (BMI), smoking status, and comorbidities. Based on our results DM has not been associated with worse outcomes in hospitalized patients for COVID-19 infection

Transferred Patients by Fars Province’s Helicopter Emergency Medical Service (HEMS); A 2-Years Cross-Sectional Study in Southern Iran

Objective: To investigate the patients transferred by helicopters, as well as an emergent medical services that were performed for them.Methods: In this retrospective cross-sectional study, all patients who were transferred by Fars province of Helicopter Emergency Medical Services (HEMS) to Shiraz hospitals, southern Iran (March 2017-March 2019) were investigated. Patients’ information was collected and analyzed includes age, gender, dispatch reason, trauma mechanisms, take hold of emergent medical services, as well as the air transportation time, time between dispatch from the origin hospital and starting the procedures, and patients’ outcome.Results: Eighty-three patients were enrolled with the mean±SD age of 36.9±19.47 years that 75.9% had trauma (p <0.0001). Mental status deterioration (25.3%) was the most dispatched indications. The mortality rate was 13.25% totally (11.11% in traumatic vs. 10% in non-traumatic). The mean±SD of air transportation time was significantly lower than ground transportation in both traumatic (p=0.0013) and non-traumatic (p <0.0001) patients. Also, the mean±SD of time between dispatch from the origin hospital and starting the procedures wasstatistically lower in air transportation in both traumatic (p=0.0028) and non-traumatic (p=0.0017) patients.Conclusion: Most of the patients transferred by HEMS were traumatic. The air transportation time as well as the time between dispatches from the origin hospital to the starting of the procedures were significantly lower in HEMS in comparison with ground transportation for both traumatic and non-traumatic patients

Status of decayed, missing, filled teeth index among Iranian children and adults: A systematic review and meta-analysis

Introduction: Oral health status is one of the health-related priorities in Iran. The present study was conducted with the aim to systematically review the status of oral health in Iran using the decayed, missing, filled teeth (DMFT) index. Methods: In this meta-analysis, all data available on DMFT were reviewed and 35 published studies were included in the study based on search strategy. To estimate overall DMFT and perform the meta-analyses, Comprehensive Meta-Analysis (CMA) software was used. Results: Of all 876 articles, 35 were included in the study. A total of 21849 individuals were included in the meta-analysis. The overall DMFT index was 3.65 [95% confidence interval (CI), 3.01-4.34]. In addition, this rate was 2.30, 8.60, and 3.85 among children, adults, and children with mental/physical disabilities with (CI 95%, 1.76-2.95), (CI 95%, 6.10-9.60), and (CI 95, 2.98-4.80), respectively. Conclusion: Mean DMFT in the assessed published data was higher than that set forth by the World Health Organization (WHO). Further planning and taking effective preventive measures to improve the oral health status seems necessary

Factors Associated with The Incidence of Coronary Heart Disease in The Mashad: A Cohort Study

Coronary heart disease (CHD) is the leading cause of morbidity and mortality globally, and specifically in Iran. Accurate assessments of Coronary heart disease (CHD) incidence is very necessary for public health. In current study we aimed to investigate the incidence of CHD and importance of several classical, modifiable and un-modifiable risk factors for CHD among an urban population in eastern Iran after 6 years of follow-up. Methods The population of MASHAD cohort study were followed up for 6 years, every 3 years in two step by phone and who reported symptoms of CVD were asked to attend for a cardiac examination, to estimate the incidence of CHD with 95% confidence interval (95% CI) as well multiple logistic regression analysis was performed to assess the association of several baseline characteristics with incidence of CHD event. Evaluation of goodness-of-fit was done using ROC analysis. CHD cases divided into four different classes which include: stable angina, unstable angina pectoris, myocardial infarction and sudden cardiac death. Results In the six years\u27 follow-up of Mashhad study, the incidence rate of all CHD event in men and women in 100,000 people-years with 95% confidence intervals were 1920 (810-3030) and 1160 (730-1590), respectively. The areas under ROC curve (AUC), based on multivariate predictors of CHD outcome, was 0.7825. Conclusion Our findings indicated that the incidence rate of coronary heart diseases in MASHAD cohort study increases with age as well as our final model designed, was able to predict approximately 78% of CHD events in Iranian population

Proinflammatory Cytokine Gene Polymorphisms in Bullous Pemphigoid

Bullous pemphigoid (BP) is a rare autoimmune skin blistering disease, characterized by the presence of autoantibodies against hemidesmosomal autoantigens. Cytokine expression is altered in BP patients, and several of these differently expressed cytokines, including IL-1α, IL-1β, IL-8, and TNF-α, contribute to disease pathogenesis. Since genetic polymorphisms in the genes of these cytokines might be implicated in susceptibility to BP disease, we aimed at testing this implication in susceptibility to BP in an Iranian cohort. Blood samples were collected from the subjects and genomic DNA was extracted. To detect the single nucleotide polymorphisms (SNPs), IL-1α (rs1800587), IL-1β (rs1143627, rs16944, rs1143634), IL-8 (rs4073), and TNF-α (rs1799964, rs1800630, rs1799724, and rs361525) genes were genotyped in BP patients and healthy controls as well as IL-8 (rs4073) in pemphigus vulgaris (PV) patients. Quantitative gene expression was evaluated by RT-PCR analysis. A significant difference was observed in the distribution of genotypes or alleles of IL-8 SNP between the BP patients and controls. The A-allele of IL-8 SNP is significantly more prevalent in the control individuals compared to the BP patient. To further validate this observation, we included PV patients as an additional control. Again, the A-allele of IL-8 SNP is significantly more prevalent in the PV compared to the BP patients. While we observed a trend toward significant differences regarding alleles of TNF-α rs1799724 as well as alleles of TNF-α rs1799964, this difference was, however, not evident after correction for multiple analysis. There was no significant difference in all other studied SNPs. In contrast to IL-1α, IL-1β, and TNF-α, IL-8 gene expression levels were significantly higher in the patients than that of controls. The minor allele in IL-8 SNP might play a protective role in susceptibility to BP in Iranian patients. Although higher expression levels of IL-8 gene was found in the patients compared with healthy controls, these levels, however, suggest no association with the examined polymorphism. Moreover, further investigation revealed an elevation in gene expression between wild and polymorphic genotypes of IL-1α rs1800587 and TNF-α rs361525 in the patient group and these SNPs are therefore associated with altering the levels of gene expression

Memory function in borderline personality disorder

Borderline Personality Disorder (BPD) is a severe psychiatric condition that involves impairment in multiple areas of psychological functioning including disturbed cognition, impulsivity, and intense unstable relationships. Memory deficits are not recognised as a core symptom of BPD, but BPD patients have long been suspected of having inaccurate perceptions, disturbed memory processes, and an increased tendency to generate false memories about past events, interpersonal perceptions, and social interactions. The overarching goal of my PhD was to investigate potential memory differences in people with features of BPD. In particular, I examined whether people with more BPD symptoms would be more susceptible to false memories or would exhibit irregularities in autobiographical memory. In addition, I also compared the traditional conceptualisation of BPD with the alternative model of personality disorders in predicting memory performance. A total of 300 university students were recruited to participate in the main experiment. Participants were asked to complete a series of psychological assessments that measured various aspects of personality and psychopathology. In addition, each participant took part in a false memory procedure, the Deese/Roediger-McDermott (DRM) paradigm, using word lists that were developed in the course of preliminary research (Chapter 4). Participants were also asked to report about both their earliest personal memory and a memory that reflected an important turning point in their lives (see Chapter 5 for the complete Method). I then examined how BPD features are associated with false memory (Chapter 6) and how dissociation is associated with false memory (Chapter 7). In the final two empirical chapters, I investigated how BPD features are related to the qualities of autobiographical narratives (Chapter 8) and how borderline symptoms are reflected in the nature of narrative identity (Chapter 9). Overall, I found that 1) using the BPD traditional model, BPD symptoms were correlated with higher false memory for positive information, and in the alternative model of BPD, identity impairment and anxiousness were correlated with the overall false memory score; 2) irrespective of BPD, experiencing trauma and dissociation, as well as lower levels of intelligence, were associated with higher false memory; 3) trauma and dissociation mediated the relation between BPD and false memory; 4) both the traditional and alternative models of BPD were correlated with negative affect in turning-point memories, but not in earliest memories; 5) relying on the traditional model of BPD, I found no correlation between over-general memories and BPD, however, using the alternative model, over-general turning-point memories were associated with higher BPD-related impairment in self-direction; 6) participants with features of BPD were more likely to rate their earliest memories as more negative in valence and less coherent; 7) participants with features of BPD were more likely to rate their turning-point memories as negative in valence, to describe them from a 3rd-person perspective, and to reflect higher distancing, greater emotional intensity, and less accessibility; 8) participants with higher features of BPD also reported turning point memories that were also less likely to reflect their sense of agency, agency fulfilment, intimacy and empathy; and 9) narrative identity, but not narrative intimacy and coherence, was the dominant predictor of BPD features. Overall, I also found that both the traditional and alternative models of BPD predict the expected qualities of memory, with the alternative model of BPD doing better in determining which diagnostic subtypes of BPD predict the trajectories of false memory. Taken together, the current findings not only have important theoretical implications for understanding memory differences in BPD, but they also have practical implications in clinical settings